Wednesday, February 11, 2015

Breastfeeding: it's hard, Part 2

As I indicated in my previous blog post, part of what caused me to struggle with the early weeks of breastfeeding was that Ruth was a tiny baby, and a slow gainer. She was born at 6 lbs, 5 oz, then dropped to 5 lbs, 12 oz before we left the hospital (a very interesting conversation took place on my Facebook wall about trying to breastfeed premies). This was an okay amount of weight loss, the max that was considered normal, so Ruth was ready to come home with us two days after her birth. Then it took her nearly three weeks to get back up to her birth weight.

At 11 weeks out, looking back at those early pictures I can understand why people were worried about her weight. She was all skin and bones, no fat whatsoever. Having very little experience with babies, I didn't know any different.

This is where I'm extremely grateful our pediatrician (who's actually a nurse practitioner) gave me the appropriate referral to a lactation consultant rather than insist that we go straight to supplementing with formula. A lactation consultant visited Ruth and I three times at home before things really picked up. I was instructed to take fenugreek (a galactagogue--a substance that increases milk production), and also to pump to increase my milk supply. Every ounce I pumped was to be fed to Ruth after she finished nursing from me. I was also told to let Ruth go no more than three hours at night without feeding (early on she was inclined to sleep slightly longer at night), and she was to wear a hat as much as possible (so she wouldn't burn extra calories trying to keep warm). We did everything we could to boost my milk production and ever so slowly she gained back the ounces.

In the meantime, while Ruth remained below her birth weight, I was in a near constant state of anxiety. Why wasn't my baby gaining fast enough? She was producing plenty of wet and dirty diapers (the best marker for whether a breastfed baby is consuming enough besides weight gain), and she seemed happy, but that wasn't enough. Tears emerged during more than one hour plus night feed because I felt I was failing to provide Ruth with what she needed. If we had extra pumped milk Andrew often offered to take over the feed, but I rarely consented.

Ruth is now up to 9 lbs (as of Saturday), putting her firmly in the bottom first to second percentile. She's happy, she's healthy, and we love her.

Here's where I kind of go against medical opinion/advice. Pediatricians seem to want all babies (I'm talking full-term babies) to gain an ounce a day, but after listening to other mothers I feel like this goal simply isn't practical (in terms of the stress parents go through trying to get their infants to gain that much).

It isn't, in fact, even possible.

According to the WHO growth curves (girls, boys) the baby gaining an ounce a day is growing on the fiftieth percentile curve, which means not every baby can gain that much (because not every baby is ON the mean). Some, at the top of the curve will gain more, some at the bottom, like Ruth, will only gain around two-thirds of an ounce a day, and that's just fine. So why physicians get all antsy over a baby gaining at a slower, but healthy rate is beyond me. It only makes parents anxious, possibly pushing them to supplement with formula when they don't need to.

I noticed one other thing when looking at the methods for how the WHO growth curves were developed. The research team used data from a variety of populations (US, Norway, Brazil, Oman, Ghana, and India), which is good, but right there in the second paragraph it says that greater than or equal to 20% of woman followed the WHO guidelines for feeding. Greater than or equal to 20%...that's a lot of room there. And when they say the WHO feeding guidelines, I believe they mean the one that says that infants should be exclusively breastfed for the first 6 months of life. So, if possibly as little at 20% of children were breastfed exclusively for 6 months in some of the sample populations, might that mean that these growth curves aren't necessarily accurate for breastfed babies?

I don't know, I'm just guessing here. Certainly, exclusively breastfed babies can be on the ninety-ninth percentile, but perhaps it shouldn't be too surprising if they aren't.

Well, that's all my thoughts on breastfeeding. It IS getting better. Ruth's growing, and I plan to keep it up for several months to come. I'll try to find something other than my baby to talk about in my next blog post. Snow, perhaps? It's a rather popular topic here in the Boston area (NOT!).



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